Management of atrial high-rate episodes detected by cardiac implanted electronic devices

Key PointsCardiac electronic implanted devices (CIEDs) readily detect atrial high-rate episodes (AHREs), which are fairly common and associated with an increased incidence of clinical atrial fibrillation, stroke, and systemic thromboembolismUp to 20% of automatically detected AHREs reflect something other than an atrial arrhythmia, and inspection of the atrial electrogram is required for verificationThe absolute risk of stroke associated with AHRE detection is lower than in patients with clinical atrial fibrillation who have similar clinical risk factors for strokeThe temporal relationship between AHREs and stroke is poor in most patients with a CIED who develop a strokeIn ∼15% of patients with stroke and a high AHRE burden, a close temporal relationship exists between the AHREs and stroke, which declines after 5 daysTwo large clinical trials of anticoagulant drugs in CIED-detected AHREs are ongoing; their outcomes will inform future management